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Noncurative Resection for Gastric Cancer Patients: Who Could Benefit?

Determining Prognostic Factors for Patient Selection

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Resections have long been recommended for patients with incurable gastric cancer. However, high morbidity rates and more efficient chemotherapy regimens have demanded more accurate patient selection. The aim of this study was to analyze the results of gastric cancer patients treated with noncurative resection in a single cancer center.

Methods

Medical charts of patients treated with a noncurative resection between January 1988 and December 2012 were analyzed. Individuals who had M1 disease were included, along with those with no metastasis but who had an R2 resection. Morbidity, mortality, and survival prognostic factors were analyzed.

Results

In the period, 192 patients were resected, 159 with previously diagnosed metastatic disease and the other 33 having resection with macroscopic residual disease (R2). A distal gastrectomy was performed in 117 patients and a total resection in 75, with a more limited lymph node dissection in 70 % of cases. A multivisceral resection was deemed necessary in 42 individuals (21.9 %). Overall morbidity was 26.6 % and 60-day mortality was 6.8 %. Splenectomy was the only independent prognostic factor for higher morbidity. Median survival was 10 months, and younger age, distal resection, and chemotherapy were independent prognostic factors for survival. A prognostic score obtained from these factors identified a 20-month median survival in patients with these favorable characteristics.

Conclusion

Noncurative surgery may be considered in selected gastric cancer patients as long as it has low morbidity and allows the realization of chemotherapy.

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References

  1. Coburn M, Lourenço LG, Rossi SE, Gunraj N, Mahar AL, Helyer LK, et al. Management of gastric cancer in Ontario. J Surg Oncol. 2010;102:55–63.

    Article  Google Scholar 

  2. Dassen AE, Lemmens VE, van de Poll-Franse LV, Creemers GJ, Brenninkmeijer SJ, Lips DJ, et al. Trends in incidence, treament and survival of gastric adenocarcinoma between 1990 and 2007: a population-based study in the Netherlands. Eur J Cancer. 2010;46:1101–10.

    Article  CAS  PubMed  Google Scholar 

  3. Cunningham D, Starling N, Rao S, Iveson T, Nicolson M, Coxon F, et al. Capecitabine and oxaliplatin for advanced esophagogastric cancer. N Engl J Med. 2008;358:36–46.

    Article  CAS  PubMed  Google Scholar 

  4. Bang YJ, Van Cutsem E, Feyereislova A, Chung HC, Shen L, Sawaki A, et al. Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, open-label, ransomised controlled trial. Lancet. 2010;376:687–97.

    Article  CAS  PubMed  Google Scholar 

  5. Lawrence W Jr, McNeer G. The effectiveness of surgery for palliation of incurable gastric cancer. Cancer. 1958;11:28–32.

    Article  PubMed  Google Scholar 

  6. Lasithiotakis K, Antoniou SA, Antoniou GA, Kaklamanos I, Zoras O. Gastrectomy for stage IV gastric cancer. A systematic review and meta-analysis. Anticancer Res. 2014;34:2079–86.

    PubMed  Google Scholar 

  7. ASA Physical Status Classification System. Available at: http://www.asahq.org/.

  8. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines. 2010 (ver. 3). Gastric Cancer. 2011;14:113–23.

    Article  Google Scholar 

  9. Dindo D, Demartines N, Clavien PA. Classification of surgical complications. Ann Surg. 2004;240:205–13.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Sobin LH, Gospodarowicz MK, Wittekind C. International Union Against Cancer (UICC) TNM classification of malignant tumours. 7th edition. New York: Wiley-Liss; 2010:73–6.

    Google Scholar 

  11. Miner TJ, Jaques DP, Karpeh MS, Brennan MF. Defining palliative surgery in patients receiving noncurative resections for gastric cancer. J Am Coll Surg. 2004;198:1013–21.

    Article  PubMed  Google Scholar 

  12. American Joint Committee on Cancer. AJCC cancer staging manual. 6th edition. Philadelphia: Lippincott Williams & Wilkins; 2002.

  13. Sun J, Song Y, Wang Z, Chen X, Gao P, Xu Y, et al. Clinical significance of palliative gastrectomy on the survival of patients with incurable advanced gastric cancer: a systematic review and meta-analysis. BMC Cancer. 2013;13:577–86.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Kodera Y, Fujitani K, Fukushima N, Ito S, Muro K, Ohashi N, et al. Surgical resection of hepatic metastasis from gastric cancer: a review and new recommendation in the Japanese gastric cancer treatment guidelines. Gastric Cancer. 2014;17:206–12.

    Article  PubMed  Google Scholar 

  15. Rudloff U, Langan RC, Mullinax JE, Beane JD, Steinberg SM, Beresnev T, et al. Impact of maximal cytoreductive surgery plus regional heated intraperitoneal chemotherapy (HIPEC) on outcome of patients with peritoneal carcinomatosis of gastric origin: results of the GYMSSA trial. J Surg Oncol. 2014;110:275–84.

    Article  PubMed  Google Scholar 

  16. Chen S, Li YF, Feng XY, Zhou ZW, Yuan XH, Chen YB. Significance of palliative gastrectomy for late-stage gastric cancer patients. J Surg Oncol. 2012;106:862–71.

    Article  PubMed  Google Scholar 

  17. Woo JW, Ryu KW, Park JY, Eom BW, Kim MJ, Yoon HM, et al. Prognostic impact of microscopic tumor involved resection margin in advanced gastric cancer patients after gastric resection. World J Surg. 2014;38:439–46.

    Article  PubMed  Google Scholar 

  18. Leake PA, Cardoso R, Seevaratnam R, Lourenço L, Helyer L, Mahar A, et al. A systematic review of the accuracy and utility of peritoneal cytology in patients with gastric cancer. Gastric Cancer. 2012;15(suppl 1):S27–37.

    Article  PubMed  Google Scholar 

  19. Lorenzen S, Panzram B, Rosenberg R, Nekarda H, Becker K, Schenk U, et al. Prognostic significance of free peritoneal tumor cells in the peritoneal cavity before and after neoadjuvant chemotherapy in patients with gastric carcinoma undergoing potentially curative resection. Ann Surg Oncol. 2010;17:2733–9.

    Article  PubMed  Google Scholar 

  20. Canbay E, Mizumoto A, Ichinose M, Ishibashi H, Sako S, Hirano M, et al. Outcome data of patients with peritoneal carcinomatosis from gastric cancer origin treated by a strategy of bidirectional chemotherapy prior to cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in a single specialized center in Japan. Ann Surg Oncol. 2014;21:1147–52.

    Article  PubMed  Google Scholar 

  21. Dittmar Y, Rauchfuss F, Goetz M, Jandt K, Scheuerlein H, Heise M, et al. Noncurative gastric resection for patients with stage 4 gastric cancer. a single center experience and current review of the literature. Langenbacks Arch Surg. 2012;397:745–53.

    Article  Google Scholar 

  22. Papenfuss WA, Kukar M, Oxenberg J, Attwood K, Nurkin S, Malhotra U, et al. Morbidity and mortality associated with gastrectomy for gastric cancer. Ann Surg Oncol. 2014;21:3008–14.

    Article  PubMed  Google Scholar 

  23. Martin RC 2nd, Jaques DP, Brennan MF, Karpeh M. Multivisceral local resection for advanced gastric cancer: increased survival versus increased morbidity. Ann Surg. 2002;236:159–65.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Mahar AL, Coburn NG, Singh S, Law C, Helyer LK. A systematic review of surgery for noncurative gastric cancer. Gastric Cancer. 2012;15(suppl 1):S125–37.

    Article  PubMed  Google Scholar 

  25. Tokunaga M, Terashima M, Tanizawa Y, Bando E, Kawamura T, Yasui H, et al. Survival benefit of palliative gastrectomy in gastric cancer patients with peritoneal metastasis. World J Surg. 2012;36:2637–43.

    Article  PubMed  Google Scholar 

  26. Chang YR, Han DS, Kong SH, Lee HJ, Kim SH, Kim WH, et al. The value of palliative gastrectomy in gastric cancer with distant metastasis. Ann Surg Oncol. 2012;19:1231–9.

    Article  PubMed  Google Scholar 

  27. Park JC, Lee YC, Kim JH, Kim YJ, Lee SK, Hyung WJ, et al. Clinicopathological aspects and prognostic value with respect to age: an analysis of 3,362 consecutive gastric cancer patients. J Surg Oncol. 2009;99:395–401.

    Article  PubMed  Google Scholar 

  28. Costa WL Jr, Coimbra FJ, Fogaroli RC, Ribeiro HS, Diniz AL, Begnami MD, et al. Adjuvant chemoradiotherapy after D2-lymphadenectomy for gastric cancer: the role of N-ratio in patient selection. Results of a single cancer center. Radiat Oncol. 2012;15:169–77.

    Article  Google Scholar 

  29. Yang HK, Tsujinaka T, Nakamura K, Kim YW, Terashima M, Han SU, et al. Randomized controlled trial of comparing gastrectomy (Gx) plus chemotherapy (CTX) with CTX alone in advanced gastric cancer (ACG) with a single non-curable factor: JCOG 0705/KGCA01 study (REGATTA). J Clin Oncol. 2015;33(15 suppl):200.

    CAS  Google Scholar 

  30. Hartgrink HH, Putter H, Kranenberg EK, Bonenkamp JJ, van de Velde CJH for the Dutch Gastric Cancer Group. Value of palliative resection in gastric cancer. Br J Surg. 2002;89:1438–43.

    Article  CAS  PubMed  Google Scholar 

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Disclosure

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Abdominal Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil

    Felipe J. F. Coimbra MD, Wilson Luiz da Costa Jr. MD, Héber S. C. Ribeiro MD, Alessandro L. Diniz MD, André Luís de Godoy MD, Igor Correia de Farias MD & Antonio Moris Cury Filho MD

  2. Department of Clinical Oncology, A. C. Camargo Cancer Center, São Paulo, Brazil

    Marcello Ferretti Fanelli MD

  3. Department of Surgical Pathology, A. C. Camargo Cancer Center, São Paulo, Brazil

    Maria Dirlei F. S. Begnami MD, PhD & Fernando Augusto Soares MD, PhD

Authors
  1. Felipe J. F. Coimbra MD
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  2. Wilson Luiz da Costa Jr. MD
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  3. Héber S. C. Ribeiro MD
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  4. Alessandro L. Diniz MD
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  5. André Luís de Godoy MD
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  6. Igor Correia de Farias MD
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  7. Antonio Moris Cury Filho MD
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  8. Marcello Ferretti Fanelli MD
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Corresponding author

Correspondence to Wilson Luiz da Costa Jr. MD.

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Coimbra, F.J.F., da Costa, W.L., Ribeiro, H.S.C. et al. Noncurative Resection for Gastric Cancer Patients: Who Could Benefit?. Ann Surg Oncol 23, 1212–1219 (2016). https://doi.org/10.1245/s10434-015-4945-x

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  • DOI: https://doi.org/10.1245/s10434-015-4945-x

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